Work Activity Report (Self-Employment) - In Office

Work Activity Report (Self-Employment)

Documents and Forms

Document Name Document Type
SSA-820-BK (revised).pdf Other-SSA-820-BK (revised)
SSA-820-BK (revised).pdf Other-SSA-820-BK (revised)
0960-0598 Privacy Act Statement (revised).docx Other-Privacy Act Statement (revised
0960-0598 Privacy Act Statement (revised).docx Other-Privacy Act Statement (revised
SSA-820-BK (current).pdf SSA-820-BK (revised) IC Document
SSA-820-BK (current).pdf SSA-820-BK (revised) IC Document

Information Collection (IC) Details

IC Title:	Work Activity Report (Self-Employment) - In Office	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1520(b) 20 CFR 404.1571-404.1576 20 CFR 404.1584-404.1593 20 CFR 416.971-416.976

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-SSA-820-BK (revised)			SSA-820-BK (revised).pdf		No		Paper Only
Other-Privacy Act Statement (revised)			0960-0598 Privacy Act Statement (revised).docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,144	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	12,144	12,144
Annual IC Time Burden (Hours)	15,180	15,180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-820-BK (revised)	SSA-820-BK (current).pdf	11/20/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.